MSNCB Endocrine Nursing 4 — Questions and Answers
Question 1: A patient's HbA1c is reported as 9.2%. Which average blood glucose level does this BEST correspond to?
- Approximately 154 mg/dL
- Approximately 212 mg/dL (Correct answer)
- Approximately 126 mg/dL
- Approximately 180 mg/dL
Correct answer: Approximately 212 mg/dL
An HbA1c of 9.2% corresponds to an estimated average glucose (eAG) of approximately 212 mg/dL over the prior 2-3 months.
Question 2: A patient with hypothyroidism is started on levothyroxine. The nurse should teach the patient to take this medication:
- At bedtime with a high-fat snack
- 30-60 minutes before breakfast on an empty stomach (Correct answer)
- Immediately after each meal three times daily
- With calcium supplements to enhance absorption
Correct answer: 30-60 minutes before breakfast on an empty stomach
Levothyroxine absorption is significantly impaired by food, calcium, and iron; it should be taken on an empty stomach 30-60 minutes before breakfast.
Question 3: Which assessment finding indicates that treatment for diabetic ketoacidosis (DKA) is effective?
- Serum glucose drops from 480 to 300 mg/dL within 30 minutes
- Serum potassium rises from 3.0 to 5.5 mEq/L
- Urine ketones clear and serum bicarbonate rises above 18 mEq/L (Correct answer)
- Blood pressure normalizes and heart rate increases
Correct answer: Urine ketones clear and serum bicarbonate rises above 18 mEq/L
Resolution of DKA is confirmed by closure of the anion gap, clearing ketones, and normalization of serum bicarbonate above 18 mEq/L.
Question 4: The nurse is preparing to administer regular insulin IV for a patient in DKA. Which action is MOST important before beginning the infusion?
- Ensure the patient has eaten a full meal
- Check serum potassium level and correct if below 3.5 mEq/L (Correct answer)
- Administer sodium bicarbonate to correct acidosis first
- Obtain a 12-lead ECG before starting any insulin
Correct answer: Check serum potassium level and correct if below 3.5 mEq/L
Insulin drives potassium intracellularly; if potassium is already low (<3.5 mEq/L), insulin administration can cause life-threatening hypokalemia.
Question 5: A patient with hyperparathyroidism would MOST likely exhibit which set of findings?
- Hypocalcemia, hyperphosphatemia, and tetany
- Hypercalcemia, hypophosphatemia, and nephrolithiasis (Correct answer)
- Hypocalcemia, hypomagnesemia, and bone pain
- Hypercalcemia, hyperkalemia, and muscle weakness
Correct answer: Hypercalcemia, hypophosphatemia, and nephrolithiasis
Excess PTH causes calcium release from bones and phosphate wasting by kidneys, leading to hypercalcemia, hypophosphatemia, and renal stones.
Question 6: Which clinical manifestation differentiates hyperosmolar hyperglycemic state (HHS) from diabetic ketoacidosis (DKA)?
- Severe dehydration is present only in HHS
- HHS presents with marked ketosis and Kussmaul respirations
- Serum glucose is typically above 600 mg/dL in HHS with minimal or no ketosis (Correct answer)
- DKA occurs only in type 2 diabetes patients
Correct answer: Serum glucose is typically above 600 mg/dL in HHS with minimal or no ketosis
HHS features extreme hyperglycemia (often >600 mg/dL) and hyperosmolarity with minimal ketosis, because residual insulin prevents ketogenesis.
Question 7: A nurse monitors a patient after surgical removal of a pheochromocytoma. Which postoperative complication is the PRIORITY concern?
- Hyperthyroidism due to surgical stress
- Severe hypotension and hypoglycemia (Correct answer)
- Acute respiratory distress syndrome
- Deep vein thrombosis formation
Correct answer: Severe hypotension and hypoglycemia
After pheochromocytoma removal, the sudden drop in catecholamines commonly causes severe hypotension; insulin hypersecretion can also trigger hypoglycemia.
MSNCB Endocrine Nursing 4
A patient's HbA1c is reported as 9.2%.
Which average blood glucose level does this BEST correspond to?